Allergist referrals for systemic reactions to imported fire ants: A community survey in an endemic area

Background: Systemic reactions to imported fire ants (IFAs) are known to be the most common cause of anaphylaxis in the southeastern United States, including Texas. Despite this reaction prevalence, referrals to allergists for evaluation and treatment of IFA reactions seem to be infrequent. Objective: To evaluate the frequency of referrals for systemic reactions to IFAs in an IFA-endemic area of the Dallas/Fort Worth metroplex. Methods: A list of all practicing allergists in the Dallas/Fort Worth metroplex was generated through allergy society membership directories and local telephone book listings. Practices that performed testing and administered immunotherapy for IFA allergy were surveyed using a written questionnaire assessing new referrals for IFA systemic reactions and perceptions of referral patterns. Results: Of 78 "allergists" initially screened, 51 indicated that they test and currently perform immunotherapy for IFA allergy. Of these 51 allergists, 35 (69%) returned completed surveys. Based on these responses, an estimated 0.6% of new patient referrals were for IFA reactions. Sixty-eight percent of respondents indicated that none to very few of all patients in their area with systemic reactions to IFA were being referred to their office for evaluation. Conclusions: Only 0.6% of new referrals to allergists' offices in an IFA-endemic area are for IFA systemic reactions. This is even lower than the estimated 2% prevalence of systemic reactions to IFA in the general population of an endemic area. Efforts to improve awareness of treatment for IFA systemic reactions for referring physicians and the public are needed.